ObesityDealing with the diagnosis

If your doctor has recently told you that you are obese, know that you are not alone. In Canada, 59 per cent of adults and 26 per cent of children are overweight and in many of these so overweight that in medical terms they are considered obese.

Tiny Bites = Big Calories

“I never eat between meals.”
“I rarely have dessert.”
“Almost everything I eat is low fat.”

Do you ever hear (or perhaps make) these comments, which are often followed by:

“So why am I still gaining weight?”

To answer that question, we often have to zoom in closer and check those ‘tiny’ bites of food that we might overlook throughout the day. For instance:

Bite 1A quarter cup of orange juice remains in the carton. You might as well finish it, right? CALORIES: 26

Bite 2Two tablespoons of granola are left in the box. It’s hardly worth returning to the cupboard. You add it to your serving of cereal. CALORIES: 64

Bite 3You add two teaspoons powdered cream substitute in the coffee at work. Someone made really strong coffee today. Adding creamer is the only way you can stand the taste. CALORIES: 20

Bite 4 You take just a small ‘sample’ of the cake in the break room. Well, maybe a second ‘sliver’ would be okay too! CALORIES: 73

Bite 5Oops! You forgot to ask them to leave the mayo off the hamburger at noon. CALORIES: 100

Bite 6You also forgot to ask them to leave off the onion! Better have a mint or two for your breath, just in case. CALORIES: 20

Bite 7 You take a chocolate kiss from the candy jar at the front desk. You have to crank out a big report this afternoon. This is for medical purposes only. CALORIES: 25

Bite 8A second chocolate kiss from the candy jar. You finished the report – what a better way to celebrate? And besides, it’s just a tiny piece of candy. CALORIES: 25

Bite 9There you are with a handful of peanuts. The gang has gotten together for a quick drink after work to celebrate completing the report. You just order mineral water, but surely a couple of teaspoons of nuts can’t have many calories. CALORIES: 105

Bite 10 Cheese on a cracker at a grocery store. After all, it’s a small sample. CALORIES: 55

Bite 11Two tablespoons of macaroni and cheese. You’re trying out a new recipe. You taste as you cook to get the seasonings just right. CALORIES: 54

Bite 12 A fourth cup of macaroni and cheese. Your new recipe tastes great, however, there’s a small amount left over. It hardly seems worth the effort to refrigerate only a fourth cup. You don’t want to toss it so you eat it. CALORIES: 108

The Grand Total ‘Extra’ Calories For the Day: 675
If these extra calories are eaten daily, it might be possible to gain as much as one pound a week! On average, an additional 3,500 calories above your body’s needs can lead to a weight gain of a pound.

Reprinted with permission of Calgary Health Region

Over the years, many of us remember hearing that we could stand to drop a few pounds. In the past, doctors rarely said more. If they did, their advice was seldom useful, along the lines of – “It’s easy, just eat a little less and move a little more!”

Times are changing. Excess weight is now seen as a disease rather than a lifestyle choice or character flaw. No one plans to eat more than necessary or thinks of being overweight as enjoyable. This new approach helps doctors to diagnose and treat weight problems.

Top Canadian researchers have prepared new guidelines for your doctor to use. (Visit www.cmaj.ca for more information.)

If you are concerned about your weight, ask for advice. Your doctor will probably be more comfortable discussing weight issues with you than ever before. If you do not mention it, do not be surprised if the topic comes up.

Your doctor will ask you about your weight history, and whether anyone else in your family shares the same struggles. We know that genetics plays a role in weight. If your parents are overweight, you are at high risk of having the same problem. Since a relationship exists between mood and weight, expect to be asked about depression and unusual eating behaviours.

How can I tell whether my weight is healthy?

A few different methods of assessing weight exist. The most common is the body mass index (BMI), calculated as weight in kg/height in metres squared. You can do this calculation yourself on the Internet. Many different BMI calculators are out there – try the one at ww2.heartandstroke.ca.

A healthy BMI is 18.5 to 24.9. A measurement between 25 and 29.9 is defined as overweight. Anything over 30 registers as that dreaded word, obese.

Many of us find the ‘o’ word harsh and hurtful. If you are told you are overweight or obese, remember that it is simply a definition of a height and weight calculation, not a judgment. Cut your doctor some slack. Many are just learning how to diagnose and manage the most common disease in North America.

Another measure of healthy weight is waist circumference. It should be less than 35 inches (88 cm) in women and less than 40 inches (102 cm) in men. After measuring your waist, the doctor will examine you and measure your blood pressure and heart rate.

Expect to make a trip to your local lab. Common tests include cholesterol, blood glucose (sugar), liver function, and kidney function. Extra weight can increase your risk of developing other problems, like diabetes and fatty liver. Detecting these early can improve your overall health and length of life.

Managing your weight

Now that you know you are overweight, it’s time to find a solution. Weight can be managed in four different ways: through nutrition, activity, medication, and surgery.

Nutrition – It is wise to bring a journal of everything you eat over three days to your doctor’s appointment. Do not be embarrassed. Your doctor will not judge you. This journal gives you and your doctor the chance to look at what you enjoy eating, and at circumstances that make you more likely to eat.

Some foods are not an obvious concern, but are less healthy choices. While the quality of sugary snacks is a no-brainer, some food items may surprise you. Your doctor will likely review Canada’s Food Guide with you. You may also want to consider contacting a registered dietitian. This professional can thoroughly evaluate your diet and help you create a healthy meal plan.

Activity – Exercise does not have to be exciting or expensive. Try to get 30 minutes of activity or more daily. You do not need to sweat! If you are inactive, start with five minutes (or less) a day. For instance, if you have trouble walking, start with chair exercises while watching television. Move any joint in your body until you are tired, then go on to the next joint.

Exercise therapists are great and can often get you started in one visit. Once you are exercising regularly, they can help you to progress.

Medications – If you have a BMI greater than 30, or greater than 27 along with other health problems, medications may be necessary. They only work well if nutrition and activity are in place.

Two main prescription drugs are available in Canada. Meridia™ helps by increasing your metabolism and decreasing your drive to eat. Xenical™ prevents your body from absorbing much of the fat you eat. In spite of people’s stories of ‘Xenical moments’, I find it really works at speeding up weight loss if you are eating well.
Medications are expensive and are not always covered by insurance plans. This is changing as our attitudes about weight change.

Surgery – Surgery is reserved for those with a BMI greater than 40, or greater than 35 when other diseases are present. Again, this only works well if you have a good diet and are exercising. Surgery is a good option for some, but the surgeon must be experienced with the procedures. Check to be sure there is a good pre and post surgery program.

Our kids and the future

Parents sometimes pass on weight problems. If we are overweight, our kids are also at risk. However, by learning to eat reasonably and becoming more active, we can pass healthier habits on to our kids so they do not share our struggles with weight.

The basics of weight management

Remember, carrying too much weight is a chronic condition. No matter what you weigh, you will always have to be careful. Learn to manage weight for the long term, not just get rid of it in the short term. Be reasonable in your approach but don’t expect perfection. Partner with your doctor and work together. Most importantly, be kind to yourself.